Thursday, May 28, 2009

The story tells the plight of Patrick Tumulty, a 54 year old male with kidney failure and a short term major medical plan.

The diagnosis was only the first shock. The second came a few weeks later, in an Aug. 5 letter from Pat's health-insurance company. For six years — since losing the last job he had that provided medical coverage — Pat had been faithfully paying premiums to Assurant Health, buying a series of six-month medical policies, one after the other, always hoping he would soon find a job that would include health coverage.

The article laments the fact that Assurant will not pay for Pat's treatment.

The author fancies herself as a bit of an expert on health care and health insurance.

When my mother, panicked, called to tell me that the insurance company was refusing to pay Pat's claims, I told her not to worry; bureaucratic mix-up, I assumed. I said I'd take care of it, bringing to bear my 15 years of experience covering health policy, sitting through endless congressional hearings on the subject and even moderating a presidential candidates' forum on the issue.

Confident of my abilities to sort this out or at least find the right person to fix the problem, I made some calls to the company. I got nowhere.

I don't know how much "hands on" the author had in helping her brother find the policy, but I do know this. The policy they bought clearly states that any condition that was diagnosed, treated or symptomatic in the 5 years prior to the application is a pre-existing condition and there is no coverage.

That's pretty straight forward.

But the author uses this as her soapbox to proclaim the health care system is broken.

Sorry. What is broken is the consumer who fails to read the details of the policy before buying.

Apparently the 15 years the author spent covering health care issues and consulting with politicians (now THAT is scary) failed to teach her even the basics about the topic.

The story tells the plight of Patrick Tumulty, a 54 year old male with kidney failure and a short term major medical plan.

The diagnosis was only the first shock. The second came a few weeks later, in an Aug. 5 letter from Pat's health-insurance company. For six years — since losing the last job he had that provided medical coverage — Pat had been faithfully paying premiums to Assurant Health, buying a series of six-month medical policies, one after the other, always hoping he would soon find a job that would include health coverage.

The article laments the fact that Assurant will not pay for Pat's treatment.

The author fancies herself as a bit of an expert on health care and health insurance.

When my mother, panicked, called to tell me that the insurance company was refusing to pay Pat's claims, I told her not to worry; bureaucratic mix-up, I assumed. I said I'd take care of it, bringing to bear my 15 years of experience covering health policy, sitting through endless congressional hearings on the subject and even moderating a presidential candidates' forum on the issue.

Confident of my abilities to sort this out or at least find the right person to fix the problem, I made some calls to the company. I got nowhere.

I don't know how much "hands on" the author had in helping her brother find the policy, but I do know this. The policy they bought clearly states that any condition that was diagnosed, treated or symptomatic in the 5 years prior to the application is a pre-existing condition and there is no coverage.

That's pretty straight forward.

But the author uses this as her soapbox to proclaim the health care system is broken.

Sorry. What is broken is the consumer who fails to read the details of the policy before buying.

Apparently the 15 years the author spent covering health care issues and consulting with politicians (now THAT is scary) failed to teach her even the basics about the topic.